TREATMENT OF T2DM PRESENT AND FUTURE

67 %
33 %
Information about TREATMENT OF T2DM PRESENT AND FUTURE
Entertainment

Published on September 5, 2008

Author: dr_paramesh

Source: authorstream.com

Dr.PARAMESH.S BSc,M.D,D.DiabMEDICAL DIRECTOR BANGALORE DIABETES CENTREMEDISYS CLINISEARCH INDIA PVT LTD : Dr.PARAMESH.S BSc,M.D,D.DiabMEDICAL DIRECTOR BANGALORE DIABETES CENTREMEDISYS CLINISEARCH INDIA PVT LTD Major Classes of Medications : Major Classes of Medications 1. Drugs that sensitize the body to insulin and/or control hepatic glucose production 2. Drugs that stimulate the pancreas to make more insulin 3. Drugs that slow the absorption of starches Thiazolidinediones Biguanides Sulfonylureas Meglitinides Alpha-glucosidase inhibitors Biguanides : Biguanides Biguanides decrease hepatic glucose production and increase insulin-mediated peripheral glucose uptake. Efficacy Decrease fasting plasma glucose 60-70 mg/dl (3.3-3.9 mmol/L) Reduce A1C 1.0-2.0% Other Effects Diarrhea and abdominal discomfort Lactic acidosis if improperly prescribed Cause small decrease in LDL cholesterol level and triglycerides No specific effect on blood pressure No weight gain, with possible modest weight loss Contraindicated in patients with impaired renal function (Serum Cr > 1.4 mg/dL for women, or 1.5 mg/dL for men) Medications in this Class: metformin (Glucophage), metformin hydrochloride extended release (Glucophage XR) Sulfonylureas : Sulfonylureas Sulfonylureas increase endogenous insulin secretion Efficacy Decrease fasting plasma glucose 60-70 mg/dl (3.3-3.9 mmol/L) Reduce A1C by 1.0-2.0% Other Effects Hypoglycemia Weight gain No specific effect on plasma lipids or blood pressure Generally the least expensive class of medication Medications in this Class: First generation sulfonylureas: chlorpropamide (Diabinese), tolazamide, acetohexamide (Dymelor), tolbutamide Second generation sulfonylureas: glyburide (Micronase, Glynase, and DiaBeta), glimepiride (Amaryl), glipizide (Glucotrol, Glucotrol XL) gliclazide (dianorm) Meglitinides : Meglitinides Meglitinides stimulate insulin secretion (rapidly and for a short duration) in the presence of glucose. Efficacy Decreases peak postprandial glucose Decreases plasma glucose 60-70 mg/dl (3.3-3.9 mmol/L) Reduce A1C 1.0-2.0% Other Effects Hypoglycemia (although may be less than with sulfonylureas if patient has a variable eating schedule) Weight gain No significant effect on plasma lipid levels Safe at higher levels of serum Cr than sulfonylureas Medications in this Class: repaglinide (Prandin), nateglinide (Starlix) Alpha-glucosidase Inhibitors : Alpha-glucosidase Inhibitors Alpha-glucosidase inhibitors block the enzymes that digest starches in the small intestine Efficacy Decrease peak postprandial glucose 40-50 mg/dl (2.2-2.8 mmol/L) Decrease fasting plasma glucose 20-30 mg/dl (1.4-1.7 mmol/L) Decrease A1C 0.5-1.0% Other Effects Flatulence or abdominal discomfort No specific effect on lipids or blood pressure No weight gain Contraindicated in patients with inflammatory bowel disease or cirrhosis Medications in this Class: acarbose (Precose), miglitol (Glyset) voglibose Thiazolidinediones : Thiazolidinediones Thiazolidinediones decrease insulin resistance by making muscle and adipose cells more sensitive to insulin. They also suppress hepatic glucose production. Efficacy Decrease fasting plasma glucose ~35-40 mg/dl (1.9-2.2 mmol/L) Reduce A1C ~0.5-1.0% 6 weeks for maximum effect Other Effects Weight gain, edema Hypoglycemia (if taken with insulin or agents that stimulate insulin release) Contraindicated in patients with abnormal liver function or CHF Improves HDL cholesterol and plasma triglycerides; usually LDL neutral Medications in this Class: pioglitazone (Actos), rosiglitazone (Avandia), [troglitazone (Rezulin) - taken off market due to liver toxicity] Efficacy of Monotherapy with Oral Diabetes Agents : Efficacy of Monotherapy with Oral Diabetes Agents DeFronzo Annals of Internal Medicine 1999;131:281-303 Nathan N Engl J Med 2002; 347:1342-1349 Management of HyperglycemiaStarting Basal Insulin : Management of HyperglycemiaStarting Basal Insulin Consider when A1C >7% on oral combination therapy Continue oral agent(s) at same dosage Add single, evening insulin dose (10 U) NPH (bedtime) Premix (evening meal) Glargine (bedtime or with evening meal) Titrate dose weekly according to fasting SMBG (FPG) Increase 4 U if FPG >140 mg/dL Increase 2 U if FPG = 120 to 140 mg/dL Treat to target (usually <120 mg/dL) Reduce morning oral agent dosage if daytime hypoglycemiaoccurs Management of HyperglycemiaAdvancing to Two Injections : Management of HyperglycemiaAdvancing to Two Injections Consider when FPG acceptable but A1C >7% on one injection Insulin options To bedtime NPH, add morning NPH To suppertime premix, add morning premix To glargine, add regular, aspart, glulisine, or lispro to main meal Oral agent options Usually stop sulfonylureas Continue metformin for weight control? Continue glitazones for glycemic stability? Management of HyperglycemiaAdvancing to Basal-Bolus Regimen : Management of HyperglycemiaAdvancing to Basal-Bolus Regimen Consider when A1C >7% on two injections Insulin options Bedtime and morning NPH + regular, aspart, glulisine, or lispro with each meal Glargine + regular, aspart, glulisine, or lispro with each meal Oral agent options Usually stop sulfonylureas Continue metformin for weight control? Continue glitazones for glycemic stability? Treatment of Type 2 Diabetes : Treatment of Type 2 Diabetes Diagnosis Slide 15: Combination Therapy for Type 2 Diabetes Biguanides Sulfonylureas Slide 16: Combination Therapy for T 2 DM Fixed Combination Pills Sulfonylurea + Biguanide Glyburide + Metformin - Glucovance Glipizide + Metformin - Metaglip Thiazolidinedione + Biguanide Rosiglitazone + Metformin - Avandamet Slide 30: AVE DUTOGLIPTIN ALOGLIPTIN B110356 SGLT INHIBITORS : SGLT INHIBITORS SGLT INHIBITORS : Sergliflozin (GW869682X) - GSK AVE 2268 -AVENTIS Dapagliflozin (BMS 512148) SGLT INHIBITORS SGLT2 inhibitors have significant potential in the treatment of type 2 diabetes as a class of drugs that can effectively lower blood glucose while avoiding weight gain, hypoglycemia, and edema

Add a comment

Related presentations

Related pages

Pathophysiology and treatment of type 2 diabetes ...

Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. ... If insulin resistance is present, ...
Read more

Present and future challenges in Type 2 diabetes. Summer 11

... that leads to the chronic liver disorder Non-Alcoholic Fatty Liver Disease ... Current widespread treatments for T2DM ... present potential T2DM ...
Read more

Pathophysiology and treatment of type 2 diabetes ...

Pathophysiology and treatment of type ... present, and future. Steven E ... when evaluating new strategies for the treatment of type 2 diabetes (T2DM), ...
Read more

The worldwide epidemiology of type 2 diabetes mellitus ...

The worldwide epidemiology of type 2 diabetes mellitus--present and future ... Prevention of T2DM is a 'whole-of-life' task and requires an integrated ...
Read more

The worldwide epidemiology of type 2 diabetes mellitus ...

Type 2 diabetes mellitus (T2DM) ... the prediction of future T2DM compared with risk models ... of Intensive Treatment of People with Screen ...
Read more

Treatment of Nonalcoholic Steatohepatitis in Adults ...

Among the emerging treatments, ... Present and Future. ... is often associated with obesity and T2DM and is present in 20–80% of patients who are ...
Read more

The Future of Insulin Therapy for Patients With Type 2 ...

The Future of Insulin Therapy for ... The present article ... and progressive chronic disease. 3 Our approach to the treatment of patients with T2DM ...
Read more

Management of Newly Diagnosed Type 2 Diabetes Mellitus ...

Type 2 diabetes mellitus (T2DM): ... or asymptomatic T2DM present ... prevention and treatment of type 2 diabetes mellitus in children, with ...
Read more

Future targets in the treatment of type 2 diabetes

Future targets in the treatment of type 2 diabetes ... and treatment of type 2 diabetes mellitus (T2DM) ... gamma agonists are developed at present.
Read more